Optimales prähospitales Management des ST-Strecken-Hebungsinfarktes

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Zusammenfassung

Das akute Koronarsyndrom gehört zu den häufigsten Einsatzdiagnosen im Rettungsdienst. Die initiale Aufgabe des Rettungsdienstpersonals ist es, die Diagnose eines ST-Strecken-Hebungs-Infarktes (STEMI) mittels Anamnese und 12-Kanal-EKG zu stellen, um dann die Entscheidung über eine Reperfusionsmaßnahme einzuleiten. Durch evidenzbasierte Kriterien werden in dieser Übersicht die Erwägungen der bevorzugten Reperfusionstherapie, d. h. primäre perkutane Koronarintervention (PCI) versus prähospitale Fibrinolyse und auch der „facilitated“ PCI, analysiert. Zusätzlich wird unter Berücksichtigung der aktuellen Literatur die begleitende analgetische, anti-ischämische, thrombozytenaggregationshemmende und antikoagulatorische Medikation für das prähospitale Management des STEMI beleuchtet.

Schlüsselwörter

Akutes Koronarsyndrom ST-Strecken-Hebungs-Infarkt Myokardinfarkt prähospitale Fibrinolyse perkutane Koronarintervention 

Optimal prehospital management of ST elevation myocardial infarction

Abstract

Acute coronary syndromes belong to the most frequent diagnoses in the prehospital setting. The initial goal of the emergency physician or paramedic is to confirm the diagnosis of ST elevation myocardial infarction (STEMI) from anamnestic data and a 12-lead ECG with subsequent immediate initiation of reperfusion. Using evidence-based criteria, the preferred reperfusion strategies, i.e., primary percutaneous coronary intervention (PCI) versus prehospital fibrinolysis and also facilitated PCI, are then considered. Finally, the current literature review also focuses on concomitant analgesic, antiischemic, platelet-inhibiting and anticoagulant medication for the prehospital management of STEMI.

Key words

acute coronary syndrome ST elevation myocardial infarction prehospital fibrinolysis percutaneous coronary intervention 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für Innere Medizin/KardiologieUniversität Leipzig – HerzzentrumLeipzigGermany

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